RALEIGH, N.C. - As North Carolina farmers work to put food on the tables of the state's residents, many are doing so without health insurance or preventive care.
According to the Agromedicine Institute, at least 30 percent of farmers and more than 90 percent of farmworkers do not have health coverage. Francesca Hyatt, Come to the Table director for Rural Advancement Foundation International, said the data points to a cultural practice among farmers.
"They just tend to really be outside of the system," she said, "and so it's been a problem for a long time that farmers have had insufficient access to health care, and farmers will be focusing on everything but their own well-being."
The Affordable Care Act could provide health coverage for some farmers, but because North Carolina did not authorize a Medicaid expansion, Hyatt said many could fall into a coverage gap based on their income and not qualify for help.
Along with a lack of access to medical care, workers in the agricultural industry in North Carolina have a 7 1/2-times greater chance of dying on the job than people in other professions. That figure also is from the Agromedicine Institute, where director Robin Tutor-Marcom noted that it's hard for farmers to make time for medical care, with many of them working during office hours.
"Traditional hours for obtaining medical care are not conducive necessarily to farmers getting care," she said.
Because the system created under the Affordable Care Act involves reporting information to the government, Hyatt said, some farmers may be hesitant to take part.
"Farmers, they tend to be suspicious of enrolling in something through the government," Hyatt said. "So, there's partly, I think, just sort of a cultural barrier, that there's a lot of mistrust about what this is."
Hyatt said it's important to note that the government considers income and not assets for deciding whether a person qualifies for federal assistance in getting health insurance.
The Agromedicine Institute serves all 100 counties in the state and is providing help to farmers as well as people in the fishing and timber industries who want information about the ACA.
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Colorado is working to boost the state's agricultural communities by getting more fresh, nutritious foods into school cafeterias - and a new online tool could help more school districts participate.
The effort is a key component of the Healthy School Meals for All initiative approved by voters in 2022.
Taylor Frederick - culinary programs manager with Nourish Colorado - said over the past couple of years, school meal operators have identified best practices that can be adopted by other school districts, including how to work with local farms and ranches.
"How you can find your local producer," said Frederick, "and even how to put out specific bids for specific local items, and how to work these sorts of things into your menus."
The new Colorado Local Food Program Guidebook, available online at 'guidebook.nourishcolorado.org,' offers tips and tools for launching and sustaining farm-to-school programs.
The guide also offers ways for parents and community members to engage with their local school district, to encourage them to opt into the voluntary program or make menu recommendations.
Frederick explained that the guide begins with a short quiz that helps direct users to the right resources.
For example, food producers who want to sell their produce to reliable kiddo customers can learn how school district cafeterias operate and purchase food.
"To better understand the school market channels," said Frederick, "the bid process, the price points that school districts are working with, their timing, and a little bit about their menus and products that they are looking for."
He said school meal operators can also get tips on how to transition from serving canned and processed foods to preparing meals with fresh ingredients through a series of training videos.
"Some different types of kitchen equipment that might be in the schools, we have training videos on those," said Frederick. "Some vegetable cookery techniques. Those were the big things that school districts and school meal authorities were really saying that they wanted."
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During National Nutrition Month, groups like Virginia Fresh Match are providing people with healthy fresh food options.
Since 2009, the coalition of farmer's markets and mobile food stores has been helping people on SNAP or EBT get access to healthier foods. Some groups have found almost 24% of the benefits are used for healthy foods, while more often they are spent on sugary snacks, premade foods, and meats.
Elizabeth Borst, director of advocacy for Virginia Fresh Match, said everyone should have the opportunity to access healthy foods.
"Just making sure that people both have access to high-quality food and that quality food is affordable to them," Borst explained. "Fresh fruits and vegetables can often be the last thing that people will choose when they are on a really limited budget, so we want to make sure that is accessible to people."
The Consumer Price Index showed food prices drastically increased between 2022 and 2023, but prices have slightly declined in 2024.
Food insecurity has been a long-standing issue for Virginians. Hunger Free America's 2023 Annual Hunger Survey found almost 774,000 people in Virginia are food insecure. Borst emphasized her group is focusing on its "food is medicine" work to ensure no one goes hungry.
While Virginia Fresh Match has been able to accomplish a lot during its multiyear history, there have been some challenges. Borst observed one long-term challenge has been funding sustainability. Like the rest of the world, the pandemic presented a significant hurdle for them, though it created some interesting changes.
"We just had a huge bump in our redemptions and usage of the program," Borst stressed. "That really didn't taper off even though there's been a 40% decrease in SNAP benefit allotments once the pandemic emergency benefits ended."
Emergency allotments provided all SNAP recipients with an additional $95 per month, affecting 470,000 families across the state.
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To reach more hungry families, one Texas nonprofit is setting up mini food markets in schools.
The Tarrant Area Food Bank in North Texas provides 60 million meals a year to families in 13 counties.
It's taking the food directly to school campuses in some lower-income neighborhoods, with what it calls "Ready-to-Learn-in-School Markets."
Food Bank President and CEO Julie Butner said the markets have changed the way they're helping the community.
"And the markets are very much like a retail experience," said Butner, "where the kiddos or the parents can go in and do shopping and get the foods that they want, that they know their families will enjoy."
The area served by the food bank has food insecurity rates that range from just over 10% in Denton County, to more than 17% in Hamilton County.
Butner said more food banks across the country are partnering with school districts to operate on school campuses. She said they hope to have 100 in-school markets by the end of the year.
The markets are established in areas that are deemed food deserts, meaning there isn't a grocery store within a one mile radius of the school - and at least half of the students qualify for free breakfast or lunch.
In addition to addressing the need for food, Butner said the markets also teach valuable skills to students.
"They're helping stock the shelves, helping family members select products, checking family members in that are receiving products," said Butner, "because you do need to qualify in order to enter the market."
According to the latest U.S. Department of Agriculture data, the number of households experiencing food insecurity rose from almost 34 million in 2021 to more than 44 million in 2022.
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